Page 11 - JSOM Winter 2022

Comparison of Warming Capabilities Between

Buddy Lite, enFlow, and Thermal Angel for
US Army Medical Personnel in Austere Conditions

A Literature Review

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Donald J. Vallier, DNP, CRNA ; Wesley J.L. Anderson, CRNA *;
Jennifer V. Snelson, CRNA ; Young J. Yauger, PhD, CRNA ; Justin R. Felix, BS ;
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Kaitlyn I Alford, RN ; William A. Bermoy, EMT 7
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ABSTRACT
US Army Forward Surgical Elements (FSEs) are highly mobile Introduction
teams that provide damage control surgery (DCS) and damage
control resuscitation (DCR) in austere locations that often lack Currently US Army FSEs provide DCS and DCR for trauma
standard hospital utilities (electricity, heat, food, and water). patients in nonlinear battle spaces with limited resources
FSEs rely on portable battery-operated intravenous (IV) fluid and equipment. FSEs traditionally extend the golden hour to
warmers to remain light and mobile. However, their ability higher echelons of care, thus increasing survivability while
to warm blood in a massive resuscitation requires additional decreasing operational risk in remote locations outside the
analysis. The purpose of this literature review is to examine traditional 60-minute medical evacuation (MEDEVAC) ring.
the three most common battery-operated IV fluid warmers as Unfortunately, FSEs are restricted in space and weight during
determined by type and quantity listed on the Mission Table transport to their mobile surgical sites, which often lack stan-
of Organization and Equipment (MTOE) of organic mobile dard utilities found in fixed medical facilities such as water,
medical units. These include the Buddy Lite, enFlow, and Ther- heat, and a reliable power source. In order to remain fully
mal Angel, which are available to deployed US Army FSEs for mission capable, FSEs transport medical equipment, supplies,
blood resuscitation therapy. Based on limited available evi- blood products, power generation capabilities, fuel, food, and
dence, the enFlow produced higher outlet temperatures, ef- water. Therefore, ideal characteristics for FSE items are small,
fectively warmed greater volumes, reached the time to peak lightweight, durable, and battery-operated.
temperature faster, and produced greatest flow rates, with cool
saline (5–10°C), compared to the Thermal Angel and Buddy Currently, three battery-operated IV fluid warmers exist for mo-
Lite. However, recently the US Food and Drug Administration bile operational units that lack central power. The Buddy Lite
(FDA) issued a Class 1 recall on enFlow cartridges. Testing (Belmont Instruments, https://belmontmedtech.com/disposable
demonstrated aluminum elution from enFlow cartridges into -accessory-categories/buddy-litetm), enFlow (MEDLINE, https://
IV solutions, thereby exposing patients to potentially unsafe www.medline.com/media/catalog/Docs/MKT/ENFLOW-
aluminum levels. The authors recommend FSE units conduct FLUID-WARMING-SYSTEM.PDF), and Thermal Angel (Estill
a 100% enFlow cartridge inventory and seek an alternative Medical Technologies, https://www.medwrench.com/equipment
IV fluid warming system prior to enFlow cartridge disposal. If /2101/estill-medical-technologies-thermal-angel-ta-200) which
an alternative does not exist, or the alternative warming sys- are used in aviation units, Special Operation Forces (SOF), and
tem does not fit mission requirements, then medical personnel FSEs. These devices are ideal for austere conditions due to their
must carefully weigh the risks and benefits associated with the small sizes, favorable weights, and battery-operated capabili-
enFlow delivery system. ties. Despite their ideal structural characteristics, their ability
to warm blood products during massive resuscitation requires
Keywords: Thermal Angel; enFlow; Buddy Lite; fluid warmer; in- additional analysis.
travenous fluids, IVF; cartridge
Three main reasons warrant additional analysis of currently
used fluid warmers. First, aviation and SOF units, along with
*Correspondence to Wesley.j.anderson.mil@mail.mil
1 CPT Donald J. Vallier and COL Wesley J.L. Anderson are certified registered nurse anesthetists affiliated with the Department of Anesthesiol-
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ogy, Brooke Army Medical Center, Fort Sam Houston, TX. LTC Jennifer Snelson is a certified registered nurse anesthetist and is the Commander
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of the 758th Medical Detachment (Forward Surgical), Dahlke, Afghanistan. LTC Young J. Yauger is an associate professor at the US Army
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Graduate Program in Anesthesia Nursing at Baylor University, Waco, TX. CPT Justin R. Felix is a captain in the US Army Medical Corps.
6 CPT Kaitlyn I. Alford is a registered nurse in the US Army Nurse Corps. SSG William A. Bermoy is an emergency medical technician in the
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US Army.
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